臺灣健保署基礎實作指引, published by 衛生福利部中央健康保險署. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/TWNHIFHIR/base/ and changes regularly. See the Directory of published versions

• Content
• Detailed Descriptions
• Mappings
• Examples
• XML
• JSON
• TTL

Resource Profile: 事前審查-Claim TWNHIBASE

此事前審查-Claim TWNHIBASE Profile說明本IG如何進一步定義FHIR的Claim Resource以呈現健保署基礎事前審查之內容

Usages:

• Examples for this Profile: Claim/cla-1
• CapabilityStatements using this Profile: 臺灣健保署基礎-用戶端(TWNHIBASE Client) and 臺灣健保署基礎-伺服端(TWNHIBASE Server)

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.subType	S This element must be supported.	1..1	CodeableConcept	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。 Binding: NHI-健保署-申報類別值集 (required)
Claim.subType.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.subType.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-apply-type (extensions allowed)
Claim.subType.coding.code	Σ This element is included in summaries.	1..1	code	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Claim.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(病人資訊-Patient TWNHIBASE)	病人資訊
Claim.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	申請日期，YYYY-MM-DD，機構自填。
Claim.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(醫事機構-Organization TWNHIBASE)	醫事機構代碼，必須存在於醫事機構基本資料檔內。
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	申請案件類別，1:一般事前審查申請 | 3:自主審查 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。 Binding: NHI-健保署-申請案件類別值集 (required)
Claim.Slices for supportingInfo		0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category		1..1	CodeableConcept	Classification of the supplied information Binding: NHI-健保署-補充資訊類別值集 (required)
Claim.Slices for supportingInfo.supportingInfo:geneInfo		0..*	BackboneElement	基因資訊
Claim.Slices for supportingInfo.supportingInfo:geneInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:geneInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:geneInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: { "coding" : [ { "system" : "https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-supporting-info-type", "code" : "geneInfo" } ] }
Claim.Slices for supportingInfo.supportingInfo:geneInfo.value[x]	S This element must be supported.	1..1	Reference(基因資訊-Observation Diagnostic TWNHIBASE)	Data to be provided
Claim.diagnosis	S This element must be supported.	1..*	BackboneElement	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.Slices for extension.extension:recordedDate	S This element must be supported.	0..*	date	診斷日期，YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】 URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
Claim.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence		1..1	positiveInt	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1	CodeableConcept	國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。 Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (preferred)
Claim.diagnosis.diagnosis[x].Slices for coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2014年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2014-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.type		0..1	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
Claim.diagnosis.type.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。請勿將醫事機構名稱、病人及醫師姓名等資訊列入結果中上傳，且不得包含HTML或XML等語法。
Claim.insurance	Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	required	NHI-健保署-申報類別值集	📦1.0.0	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	required	NHI-健保署-申請案件類別值集	📦1.0.0	This IG
Claim.supportingInfo.​category	Base	required	NHI-健保署-補充資訊類別值集	📦1.0.0	This IG
Claim.supportingInfo:geneInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	preferred	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2023	Base	extensible	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2014	Base	extensible	臺灣健保署2014年中文版ICD-10-CM值集	📦2017-07-19	臺灣核心實作指引 v0.3
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.subType	S This element must be supported.	1..1	CodeableConcept	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。 Binding: NHI-健保署-申報類別值集 (required)
Claim.subType.coding		1..1	Coding	Code defined by a terminology system
Claim.subType.coding.system		1..1	uri	Identity of the terminology system Required Pattern: https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-apply-type (extensions allowed)
Claim.subType.coding.code		1..1	code	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Claim.patient	S This element must be supported.	1..1	Reference(病人資訊-Patient TWNHIBASE)	病人資訊
Claim.created	S This element must be supported.	1..1	dateTime	申請日期，YYYY-MM-DD，機構自填。
Claim.provider	S This element must be supported.	1..1	Reference(醫事機構-Organization TWNHIBASE)	醫事機構代碼，必須存在於醫事機構基本資料檔內。
Claim.priority		1..1	CodeableConcept	申請案件類別，1:一般事前審查申請 | 3:自主審查 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。 Binding: NHI-健保署-申請案件類別值集 (required)
Claim.Slices for supportingInfo		0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.category		1..1	CodeableConcept	Classification of the supplied information Binding: NHI-健保署-補充資訊類別值集 (required)
Claim.Slices for supportingInfo.supportingInfo:geneInfo		0..*	BackboneElement	基因資訊
Claim.Slices for supportingInfo.supportingInfo:geneInfo.category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: { "coding" : [ { "system" : "https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-supporting-info-type", "code" : "geneInfo" } ] }
Claim.Slices for supportingInfo.supportingInfo:geneInfo.timing[x]		0..0		When it occurred
Claim.Slices for supportingInfo.supportingInfo:geneInfo.value[x]	S This element must be supported.	1..1	Reference(基因資訊-Observation Diagnostic TWNHIBASE)	Data to be provided
Claim.diagnosis	S This element must be supported.	1..*	BackboneElement	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.Slices for extension.extension:recordedDate	S This element must be supported.	0..*	date	診斷日期，YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】 URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
Claim.diagnosis.sequence		1..1	positiveInt	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1	CodeableConcept	國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。 Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (preferred)
Claim.diagnosis.diagnosis[x].Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023	S This element must be supported.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.system	S This element must be supported.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.code	S This element must be supported.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014	S This element must be supported.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2014年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.system	S This element must be supported.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2014-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.code	S This element must be supported.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.type		0..1	CodeableConcept	Timing or nature of the diagnosis
Claim.diagnosis.type.text	S This element must be supported.	1..1	string	簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。請勿將醫事機構名稱、病人及醫師姓名等資訊列入結果中上傳，且不得包含HTML或XML等語法。
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.subType	Base	required	NHI-健保署-申報類別值集	📦1.0.0	This IG
Claim.priority	Base	required	NHI-健保署-申請案件類別值集	📦1.0.0	This IG
Claim.supportingInfo.​category	Base	required	NHI-健保署-補充資訊類別值集	📦1.0.0	This IG
Claim.diagnosis.diagnosis[x]	Base	preferred	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2023	Base	extensible	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2014	Base	extensible	臺灣健保署2014年中文版ICD-10-CM值集	📦2017-07-19	臺灣核心實作指引 v0.3

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Claim.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Claim.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Claim.contained		0..*	Resource	Contained, inline Resources
Claim.extension		0..*	Extension	Additional content defined by implementations
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier		0..*	Identifier	Business Identifier for claim
Claim.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.subType	S This element must be supported.	1..1	CodeableConcept	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。 Binding: NHI-健保署-申報類別值集 (required)
Claim.subType.id		0..1	string	Unique id for inter-element referencing
Claim.subType.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.subType.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.subType.coding.id		0..1	string	Unique id for inter-element referencing
Claim.subType.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.subType.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-apply-type (extensions allowed)
Claim.subType.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.subType.coding.code	Σ This element is included in summaries.	1..1	code	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Claim.subType.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.subType.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.subType.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(病人資訊-Patient TWNHIBASE)	病人資訊
Claim.billablePeriod	Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim
Claim.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	申請日期，YYYY-MM-DD，機構自填。
Claim.enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
Claim.insurer	Σ This element is included in summaries.	0..1	Reference(Organization)	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(醫事機構-Organization TWNHIBASE)	醫事機構代碼，必須存在於醫事機構基本資料檔內。
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	申請案件類別，1:一般事前審查申請 | 3:自主審查 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。 Binding: NHI-健保署-申請案件類別值集 (required)
Claim.fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
Claim.related		0..*	BackboneElement	Prior or corollary claims
Claim.related.id		0..1	string	Unique id for inter-element referencing
Claim.related.extension		0..*	Extension	Additional content defined by implementations
Claim.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.related.claim		0..1	Reference(Claim)	Reference to the related claim
Claim.related.relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
Claim.related.reference		0..1	Identifier	File or case reference
Claim.prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
Claim.originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
Claim.payee		0..1	BackboneElement	Recipient of benefits payable
Claim.payee.id		0..1	string	Unique id for inter-element referencing
Claim.payee.extension		0..*	Extension	Additional content defined by implementations
Claim.payee.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.payee.type		1..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
Claim.payee.party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
Claim.referral		0..1	Reference(ServiceRequest)	Treatment referral
Claim.facility		0..1	Reference(Location)	Servicing facility
Claim.careTeam		0..*	BackboneElement	Members of the care team
Claim.careTeam.id		0..1	string	Unique id for inter-element referencing
Claim.careTeam.extension		0..*	Extension	Additional content defined by implementations
Claim.careTeam.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.careTeam.sequence		1..1	positiveInt	Order of care team
Claim.careTeam.provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
Claim.careTeam.responsible		0..1	boolean	Indicator of the lead practitioner
Claim.careTeam.role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
Claim.careTeam.qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
Claim.Slices for supportingInfo		0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:All Slices.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category		1..1	CodeableConcept	Classification of the supplied information Binding: NHI-健保署-補充資訊類別值集 (required)
Claim.Slices for supportingInfo.supportingInfo:All Slices.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x]		0..1		When it occurred
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingDate			date
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingPeriod			Period
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x]		0..1		Data to be provided
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean			boolean
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString			string
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity			Quantity
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment			Attachment
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference			Reference(Resource)
Claim.Slices for supportingInfo.supportingInfo:All Slices.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:geneInfo		0..*	BackboneElement	基因資訊
Claim.Slices for supportingInfo.supportingInfo:geneInfo.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:geneInfo.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:geneInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:geneInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:geneInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: { "coding" : [ { "system" : "https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-supporting-info-type", "code" : "geneInfo" } ] }
Claim.Slices for supportingInfo.supportingInfo:geneInfo.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:geneInfo.value[x]	S This element must be supported.	1..1	Reference(基因資訊-Observation Diagnostic TWNHIBASE)	Data to be provided
Claim.Slices for supportingInfo.supportingInfo:geneInfo.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.diagnosis	S This element must be supported.	1..*	BackboneElement	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.Slices for extension.extension:recordedDate	S This element must be supported.	0..*	date	診斷日期，YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】 URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
Claim.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence		1..1	positiveInt	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1	CodeableConcept	國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。 Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (preferred)
Claim.diagnosis.diagnosis[x].id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.diagnosis[x].extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.diagnosis.diagnosis[x].Slices for coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2014年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2014-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.diagnosis.diagnosis[x].text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.diagnosis.type		0..1	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
Claim.diagnosis.type.id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.type.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.diagnosis.type.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
Claim.diagnosis.type.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。請勿將醫事機構名稱、病人及醫師姓名等資訊列入結果中上傳，且不得包含HTML或XML等語法。
Claim.diagnosis.onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
Claim.diagnosis.packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Claim.procedure		0..*	BackboneElement	Clinical procedures performed
Claim.procedure.id		0..1	string	Unique id for inter-element referencing
Claim.procedure.extension		0..*	Extension	Additional content defined by implementations
Claim.procedure.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence		1..1	positiveInt	Procedure instance identifier
Claim.procedure.type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
Claim.procedure.date		0..1	dateTime	When the procedure was performed
Claim.procedure.procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
Claim.procedure.procedure[x].procedureCodeableConcept			CodeableConcept
Claim.procedure.procedure[x].procedureReference			Reference(Procedure)
Claim.procedure.udi		0..*	Reference(Device)	Unique device identifier
Claim.insurance	Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
Claim.insurance.id		0..1	string	Unique id for inter-element referencing
Claim.insurance.extension		0..*	Extension	Additional content defined by implementations
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..*	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
Claim.accident		0..1	BackboneElement	Details of the event
Claim.accident.id		0..1	string	Unique id for inter-element referencing
Claim.accident.extension		0..*	Extension	Additional content defined by implementations
Claim.accident.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.accident.date		1..1	date	When the incident occurred
Claim.accident.type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
Claim.accident.location[x]		0..1		Where the event occurred
Claim.accident.location[x].locationAddress			Address
Claim.accident.location[x].locationReference			Reference(Location)
Claim.item		0..*	BackboneElement	Product or service provided
Claim.item.id		0..1	string	Unique id for inter-element referencing
Claim.item.extension		0..*	Extension	Additional content defined by implementations
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.careTeamSequence		0..*	positiveInt	Applicable careTeam members
Claim.item.diagnosisSequence		0..*	positiveInt	Applicable diagnoses
Claim.item.procedureSequence		0..*	positiveInt	Applicable procedures
Claim.item.informationSequence		0..*	positiveInt	Applicable exception and supporting information
Claim.item.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.serviced[x]		0..1		Date or dates of service or product delivery
Claim.item.serviced[x].servicedDate			date
Claim.item.serviced[x].servicedPeriod			Period
Claim.item.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.item.location[x].locationCodeableConcept			CodeableConcept
Claim.item.location[x].locationAddress			Address
Claim.item.location[x].locationReference			Reference(Location)
Claim.item.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.factor		0..1	decimal	Price scaling factor
Claim.item.net		0..1	Money	Total item cost
Claim.item.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.item.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item
Claim.item.detail		0..*	BackboneElement	Product or service provided
Claim.item.detail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.net		0..1	Money	Total item cost
Claim.item.detail.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.detail.subDetail		0..*	BackboneElement	Product or service provided
Claim.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.subDetail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.subDetail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.subDetail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.subDetail.net		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
Claim.total		0..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	required	NHI-健保署-申報類別值集	📦1.0.0	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	required	NHI-健保署-申請案件類別值集	📦1.0.0	This IG
Claim.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	required	NHI-健保署-補充資訊類別值集	📦1.0.0	This IG
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:geneInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:geneInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:geneInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	preferred	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2023	Base	extensible	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2014	Base	extensible	臺灣健保署2014年中文版ICD-10-CM值集	📦2017-07-19	臺灣核心實作指引 v0.3
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v7.4
Claim.item.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
Claim.item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
Claim.item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
sqty-1	error	Claim.item.quantity, Claim.item.detail.quantity, Claim.item.detail.subDetail.quantity	The comparator is not used on a SimpleQuantity	comparator.empty()

This structure is derived from Claim

Summary

Mandatory: 5 elements(6 nested mandatory elements)
Must-Support: 15 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

• 病人資訊-Patient TWNHIBASE (https://nhicore.nhi.gov.tw/base/StructureDefinition/Patient-twnhibase)
• 醫事機構-Organization TWNHIBASE (https://nhicore.nhi.gov.tw/base/StructureDefinition/Organization-twnhibase)
• 基因資訊-Observation Diagnostic TWNHIBASE (https://nhicore.nhi.gov.tw/base/StructureDefinition/Observation-diagnostic-twnhibase)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Claim.supportingInfo
• The element 1 is sliced based on the value of Claim.diagnosis.diagnosis[x].coding (Closed)

Key Elements View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.subType	S This element must be supported.	1..1	CodeableConcept	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。 Binding: NHI-健保署-申報類別值集 (required)
Claim.subType.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.subType.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-apply-type (extensions allowed)
Claim.subType.coding.code	Σ This element is included in summaries.	1..1	code	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Claim.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(病人資訊-Patient TWNHIBASE)	病人資訊
Claim.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	申請日期，YYYY-MM-DD，機構自填。
Claim.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(醫事機構-Organization TWNHIBASE)	醫事機構代碼，必須存在於醫事機構基本資料檔內。
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	申請案件類別，1:一般事前審查申請 | 3:自主審查 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。 Binding: NHI-健保署-申請案件類別值集 (required)
Claim.Slices for supportingInfo		0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category		1..1	CodeableConcept	Classification of the supplied information Binding: NHI-健保署-補充資訊類別值集 (required)
Claim.Slices for supportingInfo.supportingInfo:geneInfo		0..*	BackboneElement	基因資訊
Claim.Slices for supportingInfo.supportingInfo:geneInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:geneInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:geneInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: { "coding" : [ { "system" : "https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-supporting-info-type", "code" : "geneInfo" } ] }
Claim.Slices for supportingInfo.supportingInfo:geneInfo.value[x]	S This element must be supported.	1..1	Reference(基因資訊-Observation Diagnostic TWNHIBASE)	Data to be provided
Claim.diagnosis	S This element must be supported.	1..*	BackboneElement	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.Slices for extension.extension:recordedDate	S This element must be supported.	0..*	date	診斷日期，YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】 URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
Claim.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence		1..1	positiveInt	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1	CodeableConcept	國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。 Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (preferred)
Claim.diagnosis.diagnosis[x].Slices for coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2014年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2014-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.type		0..1	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
Claim.diagnosis.type.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。請勿將醫事機構名稱、病人及醫師姓名等資訊列入結果中上傳，且不得包含HTML或XML等語法。
Claim.insurance	Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	required	NHI-健保署-申報類別值集	📦1.0.0	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	required	NHI-健保署-申請案件類別值集	📦1.0.0	This IG
Claim.supportingInfo.​category	Base	required	NHI-健保署-補充資訊類別值集	📦1.0.0	This IG
Claim.supportingInfo:geneInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	preferred	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2023	Base	extensible	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2014	Base	extensible	臺灣健保署2014年中文版ICD-10-CM值集	📦2017-07-19	臺灣核心實作指引 v0.3
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()

Differential View

This structure is derived from Claim

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.subType	S This element must be supported.	1..1	CodeableConcept	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。 Binding: NHI-健保署-申報類別值集 (required)
Claim.subType.coding		1..1	Coding	Code defined by a terminology system
Claim.subType.coding.system		1..1	uri	Identity of the terminology system Required Pattern: https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-apply-type (extensions allowed)
Claim.subType.coding.code		1..1	code	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Claim.patient	S This element must be supported.	1..1	Reference(病人資訊-Patient TWNHIBASE)	病人資訊
Claim.created	S This element must be supported.	1..1	dateTime	申請日期，YYYY-MM-DD，機構自填。
Claim.provider	S This element must be supported.	1..1	Reference(醫事機構-Organization TWNHIBASE)	醫事機構代碼，必須存在於醫事機構基本資料檔內。
Claim.priority		1..1	CodeableConcept	申請案件類別，1:一般事前審查申請 | 3:自主審查 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。 Binding: NHI-健保署-申請案件類別值集 (required)
Claim.Slices for supportingInfo		0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.category		1..1	CodeableConcept	Classification of the supplied information Binding: NHI-健保署-補充資訊類別值集 (required)
Claim.Slices for supportingInfo.supportingInfo:geneInfo		0..*	BackboneElement	基因資訊
Claim.Slices for supportingInfo.supportingInfo:geneInfo.category		1..1	CodeableConcept	Classification of the supplied information Required Pattern: { "coding" : [ { "system" : "https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-supporting-info-type", "code" : "geneInfo" } ] }
Claim.Slices for supportingInfo.supportingInfo:geneInfo.timing[x]		0..0		When it occurred
Claim.Slices for supportingInfo.supportingInfo:geneInfo.value[x]	S This element must be supported.	1..1	Reference(基因資訊-Observation Diagnostic TWNHIBASE)	Data to be provided
Claim.diagnosis	S This element must be supported.	1..*	BackboneElement	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.Slices for extension.extension:recordedDate	S This element must be supported.	0..*	date	診斷日期，YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】 URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
Claim.diagnosis.sequence		1..1	positiveInt	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1	CodeableConcept	國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。 Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (preferred)
Claim.diagnosis.diagnosis[x].Slices for coding		0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023	S This element must be supported.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.system	S This element must be supported.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.code	S This element must be supported.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014	S This element must be supported.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2014年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.system	S This element must be supported.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2014-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.code	S This element must be supported.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.type		0..1	CodeableConcept	Timing or nature of the diagnosis
Claim.diagnosis.type.text	S This element must be supported.	1..1	string	簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。請勿將醫事機構名稱、病人及醫師姓名等資訊列入結果中上傳，且不得包含HTML或XML等語法。
Documentation for this format

Terminology Bindings (Differential)

Path	Status	Usage	ValueSet	Version	Source
Claim.subType	Base	required	NHI-健保署-申報類別值集	📦1.0.0	This IG
Claim.priority	Base	required	NHI-健保署-申請案件類別值集	📦1.0.0	This IG
Claim.supportingInfo.​category	Base	required	NHI-健保署-補充資訊類別值集	📦1.0.0	This IG
Claim.diagnosis.diagnosis[x]	Base	preferred	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2023	Base	extensible	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2014	Base	extensible	臺灣健保署2014年中文版ICD-10-CM值集	📦2017-07-19	臺灣核心實作指引 v0.3

Snapshot View

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Claim		0..*	Claim	Claim, Pre-determination or Pre-authorization
Claim.id	Σ This element is included in summaries.	0..1	id	Logical id of this artifact
Claim.meta	Σ This element is included in summaries.	0..1	Meta	Metadata about the resource
Claim.implicitRules	?! This element is a modifier element. Σ This element is included in summaries.	0..1	uri	A set of rules under which this content was created
Claim.language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
Claim.text		0..1	Narrative	Text summary of the resource, for human interpretation This profile does not constrain the narrative in regard to content, language, or traceability to data elements
Claim.contained		0..*	Resource	Contained, inline Resources
Claim.extension		0..*	Extension	Additional content defined by implementations
Claim.modifierExtension	?! This element is a modifier element.	0..*	Extension	Extensions that cannot be ignored
Claim.identifier		0..*	Identifier	Business Identifier for claim
Claim.status	?! This element is a modifier element. Σ This element is included in summaries.	1..1	code	active | cancelled | draft | entered-in-error Binding: FinancialResourceStatusCodes (required): A code specifying the state of the resource instance.
Claim.type	Σ This element is included in summaries.	1..1	CodeableConcept	Category or discipline Binding: ClaimTypeCodes (extensible): The type or discipline-style of the claim.
Claim.subType	S This element must be supported.	1..1	CodeableConcept	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。 Binding: NHI-健保署-申報類別值集 (required)
Claim.subType.id		0..1	string	Unique id for inter-element referencing
Claim.subType.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.subType.coding	Σ This element is included in summaries.	1..1	Coding	Code defined by a terminology system
Claim.subType.coding.id		0..1	string	Unique id for inter-element referencing
Claim.subType.coding.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.subType.coding.system	Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-apply-type (extensions allowed)
Claim.subType.coding.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.subType.coding.code	Σ This element is included in summaries.	1..1	code	申報類別，1:送核 | 2:送核補件 | 3:申復 | 4:爭議審議 | 5:申復補件 。
Claim.subType.coding.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.subType.coding.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.subType.text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.use	Σ This element is included in summaries.	1..1	code	claim | preauthorization | predetermination Binding: Use (required): The purpose of the Claim: predetermination, preauthorization, claim.
Claim.patient	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(病人資訊-Patient TWNHIBASE)	病人資訊
Claim.billablePeriod	Σ This element is included in summaries.	0..1	Period	Relevant time frame for the claim
Claim.created	S This element must be supported. Σ This element is included in summaries.	1..1	dateTime	申請日期，YYYY-MM-DD，機構自填。
Claim.enterer		0..1	Reference(Practitioner | PractitionerRole)	Author of the claim
Claim.insurer	Σ This element is included in summaries.	0..1	Reference(Organization)	Target
Claim.provider	S This element must be supported. Σ This element is included in summaries.	1..1	Reference(醫事機構-Organization TWNHIBASE)	醫事機構代碼，必須存在於醫事機構基本資料檔內。
Claim.priority	Σ This element is included in summaries.	1..1	CodeableConcept	申請案件類別，1:一般事前審查申請 | 3:自主審查 | 4:緊急報備；專審系統識別用，對應PXXT_CODE(TMHB,001)。 Binding: NHI-健保署-申請案件類別值集 (required)
Claim.fundsReserve		0..1	CodeableConcept	For whom to reserve funds Binding: Funds Reservation Codes (example): For whom funds are to be reserved: (Patient, Provider, None).
Claim.related		0..*	BackboneElement	Prior or corollary claims
Claim.related.id		0..1	string	Unique id for inter-element referencing
Claim.related.extension		0..*	Extension	Additional content defined by implementations
Claim.related.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.related.claim		0..1	Reference(Claim)	Reference to the related claim
Claim.related.relationship		0..1	CodeableConcept	How the reference claim is related Binding: ExampleRelatedClaimRelationshipCodes (example): Relationship of this claim to a related Claim.
Claim.related.reference		0..1	Identifier	File or case reference
Claim.prescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Prescription authorizing services and products
Claim.originalPrescription		0..1	Reference(DeviceRequest | MedicationRequest | VisionPrescription)	Original prescription if superseded by fulfiller
Claim.payee		0..1	BackboneElement	Recipient of benefits payable
Claim.payee.id		0..1	string	Unique id for inter-element referencing
Claim.payee.extension		0..*	Extension	Additional content defined by implementations
Claim.payee.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.payee.type		1..1	CodeableConcept	Category of recipient Binding: Claim Payee Type Codes (example): A code for the party to be reimbursed.
Claim.payee.party		0..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson)	Recipient reference
Claim.referral		0..1	Reference(ServiceRequest)	Treatment referral
Claim.facility		0..1	Reference(Location)	Servicing facility
Claim.careTeam		0..*	BackboneElement	Members of the care team
Claim.careTeam.id		0..1	string	Unique id for inter-element referencing
Claim.careTeam.extension		0..*	Extension	Additional content defined by implementations
Claim.careTeam.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.careTeam.sequence		1..1	positiveInt	Order of care team
Claim.careTeam.provider		1..1	Reference(Practitioner | PractitionerRole | Organization)	Practitioner or organization
Claim.careTeam.responsible		0..1	boolean	Indicator of the lead practitioner
Claim.careTeam.role		0..1	CodeableConcept	Function within the team Binding: ClaimCareTeamRoleCodes (example): The role codes for the care team members.
Claim.careTeam.qualification		0..1	CodeableConcept	Practitioner credential or specialization Binding: ExampleProviderQualificationCodes (example): Provider professional qualifications.
Claim.Slices for supportingInfo		0..*	BackboneElement	Supporting information Slice: Unordered, Open by value:category Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.Slices for supportingInfo.supportingInfo:All Slices				Content/Rules for all slices
Claim.Slices for supportingInfo.supportingInfo:All Slices.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:All Slices.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:All Slices.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:All Slices.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:All Slices.category		1..1	CodeableConcept	Classification of the supplied information Binding: NHI-健保署-補充資訊類別值集 (required)
Claim.Slices for supportingInfo.supportingInfo:All Slices.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x]		0..1		When it occurred
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingDate			date
Claim.Slices for supportingInfo.supportingInfo:All Slices.timing[x].timingPeriod			Period
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x]		0..1		Data to be provided
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueBoolean			boolean
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueString			string
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueQuantity			Quantity
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueAttachment			Attachment
Claim.Slices for supportingInfo.supportingInfo:All Slices.value[x].valueReference			Reference(Resource)
Claim.Slices for supportingInfo.supportingInfo:All Slices.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.Slices for supportingInfo.supportingInfo:geneInfo		0..*	BackboneElement	基因資訊
Claim.Slices for supportingInfo.supportingInfo:geneInfo.id		0..1	string	Unique id for inter-element referencing
Claim.Slices for supportingInfo.supportingInfo:geneInfo.extension		0..*	Extension	Additional content defined by implementations
Claim.Slices for supportingInfo.supportingInfo:geneInfo.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.Slices for supportingInfo.supportingInfo:geneInfo.sequence		1..1	positiveInt	Information instance identifier
Claim.Slices for supportingInfo.supportingInfo:geneInfo.category		1..1	CodeableConcept	Classification of the supplied information Binding: ClaimInformationCategoryCodes (example): The valuset used for additional information category codes. Required Pattern: { "coding" : [ { "system" : "https://nhicore.nhi.gov.tw/base/CodeSystem/nhi-supporting-info-type", "code" : "geneInfo" } ] }
Claim.Slices for supportingInfo.supportingInfo:geneInfo.code		0..1	CodeableConcept	Type of information Binding: ExceptionCodes (example): The valuset used for additional information codes.
Claim.Slices for supportingInfo.supportingInfo:geneInfo.value[x]	S This element must be supported.	1..1	Reference(基因資訊-Observation Diagnostic TWNHIBASE)	Data to be provided
Claim.Slices for supportingInfo.supportingInfo:geneInfo.reason		0..1	CodeableConcept	Explanation for the information Binding: MissingToothReasonCodes (example): Reason codes for the missing teeth.
Claim.diagnosis	S This element must be supported.	1..*	BackboneElement	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.Slices for extension.extension:recordedDate	S This element must be supported.	0..*	date	診斷日期，YYYY-MM-DD，西元年月日。【此為參考Da Vinci PAS IG的extension設計】 URL: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate
Claim.diagnosis.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.diagnosis.sequence		1..1	positiveInt	sequence=1時為主要疾病；sequence>=2代表共病。
Claim.diagnosis.diagnosis[x]	S This element must be supported.	1..1	CodeableConcept	國際疾病分類代碼(含共病)，當前疾病狀態。ICD-10-CM。 Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (preferred)
Claim.diagnosis.diagnosis[x].id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.diagnosis[x].extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.diagnosis.diagnosis[x].Slices for coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system Slice: Unordered, Closed by value:system Slicing Note: The rules on this element (including its children) apply to all the slices, but are not repeated in them
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2023年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2023-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2023.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014	S This element must be supported. Σ This element is included in summaries.	0..1	Coding	Code defined by a terminology system Binding: 臺灣健保署2014年中文版ICD-10-CM值集 (extensible)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.system	S This element must be supported. Σ This element is included in summaries.	1..1	uri	Identity of the terminology system Required Pattern: https://twcore.mohw.gov.tw/ig/twcore/CodeSystem/icd-10-cm-2014-tw (extensions allowed)
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.version	Σ This element is included in summaries.	0..1	string	Version of the system - if relevant
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.code	S This element must be supported. Σ This element is included in summaries.	1..1	code	Symbol in syntax defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.display	Σ This element is included in summaries.	0..1	string	Representation defined by the system
Claim.diagnosis.diagnosis[x].Slices for coding.coding:icd10-cm-2014.userSelected	Σ This element is included in summaries.	0..1	boolean	If this coding was chosen directly by the user
Claim.diagnosis.diagnosis[x].text	Σ This element is included in summaries.	0..1	string	Plain text representation of the concept
Claim.diagnosis.type		0..1	CodeableConcept	Timing or nature of the diagnosis Binding: ExampleDiagnosisTypeCodes (example): The type of the diagnosis: admitting, principal, discharge.
Claim.diagnosis.type.id		0..1	string	Unique id for inter-element referencing
Claim.diagnosis.type.extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
Claim.diagnosis.type.coding	Σ This element is included in summaries.	0..*	Coding	Code defined by a terminology system
Claim.diagnosis.type.text	S This element must be supported. Σ This element is included in summaries.	1..1	string	簡要病摘(申請理由)。連結院內HIS系統之簡要病摘，或填寫原事前審查之申請理由。請勿將醫事機構名稱、病人及醫師姓名等資訊列入結果中上傳，且不得包含HTML或XML等語法。
Claim.diagnosis.onAdmission		0..1	CodeableConcept	Present on admission Binding: ExampleDiagnosisOnAdmissionCodes (example): Present on admission.
Claim.diagnosis.packageCode		0..1	CodeableConcept	Package billing code Binding: ExampleDiagnosisRelatedGroupCodes (example): The DRG codes associated with the diagnosis.
Claim.procedure		0..*	BackboneElement	Clinical procedures performed
Claim.procedure.id		0..1	string	Unique id for inter-element referencing
Claim.procedure.extension		0..*	Extension	Additional content defined by implementations
Claim.procedure.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.procedure.sequence		1..1	positiveInt	Procedure instance identifier
Claim.procedure.type		0..*	CodeableConcept	Category of Procedure Binding: ExampleProcedureTypeCodes (example): Example procedure type codes.
Claim.procedure.date		0..1	dateTime	When the procedure was performed
Claim.procedure.procedure[x]		1..1		Specific clinical procedure Binding: ICD-10ProcedureCodes (example): Example ICD10 Procedure codes.
Claim.procedure.procedure[x].procedureCodeableConcept			CodeableConcept
Claim.procedure.procedure[x].procedureReference			Reference(Procedure)
Claim.procedure.udi		0..*	Reference(Device)	Unique device identifier
Claim.insurance	Σ This element is included in summaries.	1..*	BackboneElement	Patient insurance information
Claim.insurance.id		0..1	string	Unique id for inter-element referencing
Claim.insurance.extension		0..*	Extension	Additional content defined by implementations
Claim.insurance.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.insurance.sequence	Σ This element is included in summaries.	1..1	positiveInt	Insurance instance identifier
Claim.insurance.focal	Σ This element is included in summaries.	1..1	boolean	Coverage to be used for adjudication
Claim.insurance.identifier		0..1	Identifier	Pre-assigned Claim number
Claim.insurance.coverage	Σ This element is included in summaries.	1..1	Reference(Coverage)	Insurance information
Claim.insurance.businessArrangement		0..1	string	Additional provider contract number
Claim.insurance.preAuthRef		0..*	string	Prior authorization reference number
Claim.insurance.claimResponse		0..1	Reference(ClaimResponse)	Adjudication results
Claim.accident		0..1	BackboneElement	Details of the event
Claim.accident.id		0..1	string	Unique id for inter-element referencing
Claim.accident.extension		0..*	Extension	Additional content defined by implementations
Claim.accident.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.accident.date		1..1	date	When the incident occurred
Claim.accident.type		0..1	CodeableConcept	The nature of the accident Binding: ActIncidentCode (extensible): Type of accident: work place, auto, etc.
Claim.accident.location[x]		0..1		Where the event occurred
Claim.accident.location[x].locationAddress			Address
Claim.accident.location[x].locationReference			Reference(Location)
Claim.item		0..*	BackboneElement	Product or service provided
Claim.item.id		0..1	string	Unique id for inter-element referencing
Claim.item.extension		0..*	Extension	Additional content defined by implementations
Claim.item.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.sequence		1..1	positiveInt	Item instance identifier
Claim.item.careTeamSequence		0..*	positiveInt	Applicable careTeam members
Claim.item.diagnosisSequence		0..*	positiveInt	Applicable diagnoses
Claim.item.procedureSequence		0..*	positiveInt	Applicable procedures
Claim.item.informationSequence		0..*	positiveInt	Applicable exception and supporting information
Claim.item.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.modifier		0..*	CodeableConcept	Product or service billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.serviced[x]		0..1		Date or dates of service or product delivery
Claim.item.serviced[x].servicedDate			date
Claim.item.serviced[x].servicedPeriod			Period
Claim.item.location[x]		0..1		Place of service or where product was supplied Binding: ExampleServicePlaceCodes (example): Place of service: pharmacy, school, prison, etc.
Claim.item.location[x].locationCodeableConcept			CodeableConcept
Claim.item.location[x].locationAddress			Address
Claim.item.location[x].locationReference			Reference(Location)
Claim.item.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.factor		0..1	decimal	Price scaling factor
Claim.item.net		0..1	Money	Total item cost
Claim.item.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.bodySite		0..1	CodeableConcept	Anatomical location Binding: OralSiteCodes (example): The code for the teeth, quadrant, sextant and arch.
Claim.item.subSite		0..*	CodeableConcept	Anatomical sub-location Binding: SurfaceCodes (example): The code for the tooth surface and surface combinations.
Claim.item.encounter		0..*	Reference(Encounter)	Encounters related to this billed item
Claim.item.detail		0..*	BackboneElement	Product or service provided
Claim.item.detail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.net		0..1	Money	Total item cost
Claim.item.detail.udi		0..*	Reference(Device)	Unique device identifier
Claim.item.detail.subDetail		0..*	BackboneElement	Product or service provided
Claim.item.detail.subDetail.id		0..1	string	Unique id for inter-element referencing
Claim.item.detail.subDetail.extension		0..*	Extension	Additional content defined by implementations
Claim.item.detail.subDetail.modifierExtension	?! This element is a modifier element. Σ This element is included in summaries.	0..*	Extension	Extensions that cannot be ignored even if unrecognized
Claim.item.detail.subDetail.sequence		1..1	positiveInt	Item instance identifier
Claim.item.detail.subDetail.revenue		0..1	CodeableConcept	Revenue or cost center code Binding: ExampleRevenueCenterCodes (example): Codes for the revenue or cost centers supplying the service and/or products.
Claim.item.detail.subDetail.category		0..1	CodeableConcept	Benefit classification Binding: BenefitCategoryCodes (example): Benefit categories such as: oral-basic, major, glasses.
Claim.item.detail.subDetail.productOrService		1..1	CodeableConcept	Billing, service, product, or drug code Binding: USCLSCodes (example): Allowable service and product codes.
Claim.item.detail.subDetail.modifier		0..*	CodeableConcept	Service/Product billing modifiers Binding: ModifierTypeCodes (example): Item type or modifiers codes, eg for Oral whether the treatment is cosmetic or associated with TMJ, or an appliance was lost or stolen.
Claim.item.detail.subDetail.programCode		0..*	CodeableConcept	Program the product or service is provided under Binding: ExampleProgramReasonCodes (example): Program specific reason codes.
Claim.item.detail.subDetail.quantity	C	0..1	SimpleQuantity(4.0.1)	Count of products or services Constraints: sqty-1
Claim.item.detail.subDetail.unitPrice		0..1	Money	Fee, charge or cost per item
Claim.item.detail.subDetail.factor		0..1	decimal	Price scaling factor
Claim.item.detail.subDetail.net		0..1	Money	Total item cost
Claim.item.detail.subDetail.udi		0..*	Reference(Device)	Unique device identifier
Claim.total		0..1	Money	Total claim cost
Documentation for this format

Terminology Bindings

Path	Status	Usage	ValueSet	Version	Source
Claim.language	Base	preferred	Common Languages	📍4.0.1	FHIR Std.
Claim.status	Base	required	Financial Resource Status Codes	📍4.0.1	FHIR Std.
Claim.type	Base	extensible	Claim Type Codes	📍4.0.1	FHIR Std.
Claim.subType	Base	required	NHI-健保署-申報類別值集	📦1.0.0	This IG
Claim.use	Base	required	Use	📍4.0.1	FHIR Std.
Claim.priority	Base	required	NHI-健保署-申請案件類別值集	📦1.0.0	This IG
Claim.fundsReserve	Base	example	FundsReserve	📍4.0.1	FHIR Std.
Claim.related.relationship	Base	example	Example Related Claim Relationship Codes	📍4.0.1	FHIR Std.
Claim.payee.type	Base	example	PayeeType	📍4.0.1	FHIR Std.
Claim.careTeam.role	Base	example	Claim Care Team Role Codes	📍4.0.1	FHIR Std.
Claim.careTeam.qualification	Base	example	Example Provider Qualification Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​category	Base	required	NHI-健保署-補充資訊類別值集	📦1.0.0	This IG
Claim.supportingInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:geneInfo.​category	Base	example	Claim Information Category Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:geneInfo.​code	Base	example	Exception Codes	📍4.0.1	FHIR Std.
Claim.supportingInfo:geneInfo.​reason	Base	example	Missing Tooth Reason Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.diagnosis[x]	Base	preferred	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2023	Base	extensible	臺灣健保署2023年中文版ICD-10-CM值集	📦2024-11-18	臺灣核心實作指引 v0.3
Claim.diagnosis.diagnosis[x].​coding:icd10-cm-2014	Base	extensible	臺灣健保署2014年中文版ICD-10-CM值集	📦2017-07-19	臺灣核心實作指引 v0.3
Claim.diagnosis.type	Base	example	Example Diagnosis Type Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.onAdmission	Base	example	Example Diagnosis on Admission Codes	📍4.0.1	FHIR Std.
Claim.diagnosis.packageCode	Base	example	Example Diagnosis Related Group Codes	📍4.0.1	FHIR Std.
Claim.procedure.type	Base	example	Example Procedure Type Codes	📍4.0.1	FHIR Std.
Claim.procedure.procedure[x]	Base	example	ICD-10 Procedure Codes	📍4.0.1	FHIR Std.
Claim.accident.type	Base	extensible	ActIncidentCode	📦3.0.0	THO v7.4
Claim.item.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.location[x]	Base	example	Example Service Place Codes	📍4.0.1	FHIR Std.
Claim.item.bodySite	Base	example	Oral Site Codes	📍4.0.1	FHIR Std.
Claim.item.subSite	Base	example	Surface Codes	📍4.0.1	FHIR Std.
Claim.item.detail.revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​revenue	Base	example	Example Revenue Center Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​category	Base	example	Benefit Category Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​productOrService	Base	example	USCLS Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​modifier	Base	example	Modifier type Codes	📍4.0.1	FHIR Std.
Claim.item.detail.subDetail.​programCode	Base	example	Example Program Reason Codes	📍4.0.1	FHIR Std.

Constraints

Id	Grade	Path(s)	Description	Expression
dom-2	error	Claim	If the resource is contained in another resource, it SHALL NOT contain nested Resources	contained.contained.empty()
dom-3	error	Claim	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource	contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Claim	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated	contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Claim	If a resource is contained in another resource, it SHALL NOT have a security label	contained.meta.security.empty()
dom-6	best practice	Claim	A resource should have narrative for robust management	text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children	hasValue() or (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both	extension.exists() != value.exists()
sqty-1	error	Claim.item.quantity, Claim.item.detail.quantity, Claim.item.detail.subDetail.quantity	The comparator is not used on a SimpleQuantity	comparator.empty()

This structure is derived from Claim

Summary

Mandatory: 5 elements(6 nested mandatory elements)
Must-Support: 15 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

• 病人資訊-Patient TWNHIBASE (https://nhicore.nhi.gov.tw/base/StructureDefinition/Patient-twnhibase)
• 醫事機構-Organization TWNHIBASE (https://nhicore.nhi.gov.tw/base/StructureDefinition/Organization-twnhibase)
• 基因資訊-Observation Diagnostic TWNHIBASE (https://nhicore.nhi.gov.tw/base/StructureDefinition/Observation-diagnostic-twnhibase)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Claim.supportingInfo
• The element 1 is sliced based on the value of Claim.diagnosis.diagnosis[x].coding (Closed)